Selective Use of the Paraophthalmic Balloon Test Occlusion (BTO) to Identify a False-Negative Subset of the Cervical Carotid BTO

Abstract

Background: The extracranial, internal carotid artery balloon test occlusion is helpful in predicting ischemic stroke resulting from operative occlusion of the internal carotid artery. However, balloon test occlusion is falsely negative in up to 20 % of patients. With selected use of the paraophthalmic internal carotid artery balloon test occlusion, our group has identified a patient subset that developed ischemia resulting from supraclinoid internal carotid artery occlusion, in spite of passing the standard balloon test occlusion. Methods: Patient charts were reviewed for all balloon test occlusion referrals over a two-year period. Diagnostic angiography and standard cervical internal carotid artery balloon test occlusion were performed. The presence of retrograde ophthalmic blood flow was determined by angiography during cervical balloon test occlusion. Balloon test occlusion was then performed in those patients who both demonstrated retrograde ophthalmic blood flow during the cervical balloon test occlusion and those who were considered candidates for planned supraclinoid internal carotid artery sacrifice during skull base surgery. Results: Ten patients were referred for carotid balloon test occlusion. One patient who refused balloon test occlusion was excluded. Two patients (2/9 or 22 %) failed the initial balloon test occlusion. Two of the seven remaining patients (and one who failed balloon test occlusion) demonstrated retrograde ophthalmic arterial flow during cervical balloon test occlusion. Of the patients who passed the initial balloon test occlusion, one failed paraophthalmic carotid artery balloon test occlusion. Surgical planning in one patient (1/7 or 14 %) was significantly modified because of the results of the paraophthalmic carotid artery balloon test occlusion. Conclusion: Paraophthalmic internal carotid artery balloon test occlusion is indicated when planning supraclinoid internal carotid artery sacrifice in patients who demonstrate retrograde ophthalmic arterial flow during uneventful cervical carotid balloon test occlusion.

Balloon test occlusion - carotid - paraophthalmic

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